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PubMed2004

Characterization of port wine stain skin erythema and melanin content using cross-polarized diffuse reflectance imaging.

BACKGROUND AND OBJECTIVES: Objective methods to assess quantitatively port wine stain (PWS) blanching in response to laser therapy are needed to improve laser therapeutic outcome. Previous studies have attempted to assess objectively PWS color based on point measurement devices. To date, these approaches have typically been limited by a number of factors such as small test area and need for contact. To address these issues, a cross-polarized diffuse reflectance imaging system and color image analysis method has been developed to evaluate quantitatively erythema and melanin content in PWS skin. STUDY DESIGN/MATERIALS AND METHODS: A cross-polarized diffuse reflectance system has been constructed to acquire high resolution digital images while minimizing artifacts such as glare, shadowing, and nonuniform illumination effects that can compromise image fidelity. Furthermore, an image analysis algorithm has also been developed to analyze normal and PWS skin in terms of CIEL*a*b* color space parameters. Using the algorithm, images of color space intensity, L*, and saturation, a*, indices have been calculated to extract quantitative metrics of melanin and erythema, respectively. RESULTS: Compared to the cross-polarized diffuse reflectance image, the a* index image enhanced the contrast in regions of high and low erythema and seems to have quasi correlation with the L* index image. In the presented PWS patient example, the relative a* index difference (Deltaa*) image showed less erythema in PWS skin after laser treatment when compared to pre-treatment values. CONCLUSIONS: Our cross-polarized imaging system and color image analysis method is a simple, noncontact technique that can indirectly provide quantitative measurement of erythema and melanin content in PWS skin.

Algorithms↗
PubMed1992

Erythema nodosum of dental origin.

The association of erythema nodosum and dental infectious foci has rarely been described in the literature. This report concerns four women who developed erythema nodosum either following dental treatment associated with gingival bleeding or due to infectious dental foci. In these cases, tooth extraction, removal of dental deposits, interrupted pulp treatment, apical periodontitis, or a relicted root were identified as causes of the development of erythema nodosum. Upon admission to the hospital, these patients also presented fever and and a maximally elevated erythrocyte sedimentation rate (ESR). In all instances, surgical treatment of the dental foci and/or administration of antibiotics rapidly led to the regression of the erythema nodosum, as well as to the normalization of body temperature and ESR. The cases described indicate that antecedent dental treatment and the possible presence of infectious dental foci should be considered in the differential diagnosis of erythema nodosum when taking the patient's medical history. This approach may avoid unnecessary, possibly invasive diagnostic procedures and can lead to rapid improvement in the patient's clinical status.

Adult↗
PubMed1981

The relationship between development of ultraviolet erythema and release of prostaglandins in guinea pig skin.

Ultraviolet erythema in the guinea pid has been in use for many years as a model for assessing the anti-inflammatory potency of non-steroidal anti-inflammatory agents, the degree of erythema usually being estimated about 2 h after u.v. exposure. Using a suction blister technique for obtaining tissue fluid from erythemic and normal skin of the guinea pig we have shown that prostaglandin output in ultraviolet-irradiated skin increases rapidly during the first 2 h after irradiation, at which time the erythema reaches near-maximal development. Flurbiprofen, a potent non-steroidal anti-inflammatory agent, almost totally prevents the appearance of prostaglandins in the blister fluid and significantly reduces the degree of erythema in the skin during this early period. However, in flurbiprofen-treated animals, although prostaglandin synthesis is also suppressed at 4 to 5 h after exposure and is still partially suppressed at 17 h, a well developed erythema nevertheless appears by 4 h. This indicates the appearance of one or more non-prostaglandin mediators in the later stages of the reaction.

Animals↗
PubMed2003

All- trans-retinoic acid-induced erythema nodosum in patients with acute promyelocytic leukemia.

Erythema nodosum associated with all- trans-retinoic acid (ATRA) for acute promyelocytic leukemia (APL) is very rare. We describe four patients with classic APL who developed erythema nodosum during ATRA therapy. Fever and subsequent multiple painful erythematous nodules over extremities developed on D11, D16, D17, and D19, respectively, after ATRA therapy. The skin biopsy taken from each patient was consistent with erythema nodosum. All patients received short course of steroids. Fever subsided rapidly and the skin lesions regressed completely. All patients achieved complete remission without withdrawal of ATRA. ATRA seemed to be the most possible etiology of erythema nodosum in our patients. Short-term use of steroid is very effective in ATRA-induced erythema nodosum.

Adult↗
PubMed1999

Precipitants in 42 cases of erythema multiforme.

UNLABELLED: A total of 42 children with erythema multiforme (aged 0.1 to 15.8 years, median 6.1 years) were treated between 1978 and 1997 at the Department of Paediatrics, University of Bern, Switzerland. Antecedent infections were noted in 30 cases: Mycoplasma pneumoniae infection (n = 14), acute upper respiratory tract disease (n = 10) and herpes simplex infection (n = 6). Four cases were associated with antecedent medication (n = 3) or immunization (n = 1). In 12 of the 30 patients in whom erythema multiforme followed an infectious disease, drugs described in the literature as inducers of erythema multiforme had been given for symptoms not suggestive of the condition. In the remaining eight children no precipitating agent could be detected. CONCLUSION: In this survey infections were found as a definite or at least presumptive trigger of erythema multiforme in 71% of cases. Drugs (including immunization) implicated as triggers of erythema multiforme played a definite causative role in 10% and a presumptive role in a further 29% of patients. In 19% of patients an associated condition was not diagnosed.

Acute Disease↗
PubMed1982

A standardized quantitative skin-test assay of allergen potency and stability: studies on the allergen dose-response curve and effect of wheal, erythema, and patient selection on assay results.

A quantitative skin-test assay of allergenic potency was developed and tested on 28 allergic patients. The best-fit linear regression line was calculated from the sum of erythema or wheal diameters obtained from four intradermal threefold serial dilutions near the endpoint. Each line must have a correlation coefficient greater than 0.85 and the slopes of reference and test extract lines must not be significantly different. The relative potency can be calculated from the horizontal distance between the reference and test lines. The between-assay reproducibility was determined by comparing references against themselves. The 95% confidence limits were 54% to 186% when erythema was used and 27% to 367% when wheal was used. The narrower limits for the assay using erythema maybe due to the 5.5 times steeper slope of erythema lines than wheal lines. Potency results on five commercial extracts were highly correlated with potency results by RAST, AgE assay, or rye I assay. Extracts with isolectric focusing patterns dissimilar from the references were of significantly lower potency by in vivo and in vitro assays. The measured potency of two low-potency short ragweed extracts varied significantly with patient sensitivity to heat-stable and heat-labile ragweed allergens, indicating that patient selection may significantly affect assay results. Dose-response lines using either histamine or short ragweed by puncture (P) and intradermal (ID) techniques in the same patient showed that P/ID dose for equal erythema response was 909 for histamine and 31,250 for ragweed. This quantitative skin-test assay is highly re[rpdicob;e, yields potency data comparable to those of in vitro tests, can be applied to studies of extract stability, and is suitable as a primary bioassay of allergenic activity.

Allergens↗
PubMed1990

Erythema elevatum diutinum in a patient with Crohn's disease.

A possible association between erythema elevatum diutinum and Crohn's disease is described. To our knowledge, erythema elevation diutinum has never been reported in a patient with Crohn's disease, nor has the disorder been considered one of the cutaneous manifestations of inflammatory bowel disease. Erythema elevatum diutinum is believed to be mediated by the deposition of circulating immune complexes in the dermal perivascular spaces. Our patient showed clinical and histopathologic findings typical of both erythema elevatum diutinum and Crohn's disease. The patient also had a positive Raji cell assay, which demonstrates the presence of a circulating immune complex. Increased levels of circulating immune complexes have been found in patients with inflammatory bowel disease, and the gastrointestinal inflammation in Crohn's disease could lead to enhanced antigenic exposure and increased formation of immune complexes. We contend that inflammatory bowel disease may have contributed to the development of erythema elevatum diutinum in our patient.

Adult↗
PubMed1990

The recovery from ultraviolet radiation-induced erythema and melanoma risk factors: a case-control study.

The proportion of subjects recovering from skin erythema induced by a single ultraviolet radiation challenge of 6 times the minimal erythema dose during a 3-week period was lower in 47 patients with stage I cutaneous melanoma than in 48 healthy control subjects with similar risk factors of increased sensitivity to ultraviolet radiation (p = 0.045). This difference indicates that the patients with melanoma were more susceptible to prolonged ultraviolet radiation-induced skin damage than the control subjects. Prolonged erythema response was significantly associated in the melanoma group with decreased minimal erythema doses (odds ratio [OR] = 11.3) and with the presence of freckles (OR = 5.5), and was associated in the control group with light eye color (OR = 5.8). Prolonged ultraviolet radiation-induced erythema is neither a unique feature of melanoma patients nor a useful marker for identifying risk groups for cutaneous melanoma.

Adult↗
PubMedDate not supplied

Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis.

Most patients with erythema migrans, the pathognomonic rash of Lyme disease, do not recall a deer tick bite. The rash is classically 5 to 68 cm of annular homogenous erythema (59%), central erythema (30%), central clearing (9%), or central purpura (2%). Serologic testing is not indicated for patients with erythema migrans, because initially, the result is usually negative. Successful treatment of a patient with erythema migrans can be accomplished with 20 days of oral doxycycline, amoxicillin, or cefuroxime axetil. Patients with Lyme arthritis usually present with a mildly painful swollen knee. Patients with Lyme arthritis have markedly positive serology and can usually be successfully treated with 28 days of oral doxycycline or amoxicillin. Some patients may have persistent effusion despite 4 to 8 weeks of antibiotics and may need synovectomy. Persistent effusion is not due to persistent infection. Antibiotic therapy for more than 8 weeks for patients with Lyme disease is not indicated. Chronic Lyme disease due to antibiotic resistant infection has not been demonstrated.

Adolescent↗
PubMed2004

Necrolytic acral erythema: response to combination therapy with interferon and ribavirin.

Necrolytic acral erythema is a papulosquamous and sometimes vesiculobullous eruption bearing clinical and histologic similarity to other necrolytic erythemas such as necrolytic migratory erythema, pseudoglucagonoma, and nutritional deficiency syndromes. Necrolytic acral erythema is distinguished by its association with hepatitis C infection and its predominantly acral distribution. We describe a pediatric patient with necrolytic acral erythema whose eruption resolved with hyperalimentation and combination interferon and ribavirin therapy, despite the persistence of detectable viral load and continued hepatic and renal insufficiency.

Acrodermatitis↗
PubMedDate not supplied

[Necrolytic migratory erythema in Waldmann's disease].

BACKGROUND: We report a case of necrolytic migratory erythema in a patient with Waldmann's disease. PATIENTS AND METHODS: A 55-year-old male patient with a history of Waldmann's disease was hospitalized for a rash on the trunk and limbs comprising annular polycyclic lesions with peripheral scaling evocative of necrolytic migratory erythema. High-protein and fatty-acid-supplemented parenteral feeding led to rapid improvement of the patient's cutaneous lesions. DISCUSSION: Waldmann's disease is characterized by intestinal lymphatic abnormalities leading to exudative intestinal disease causing protein loss in the bowel lumen and deficient fatty acid absorption. The pathogenesis of necrolytic migratory erythema is not fully understood. Increased serum glucagon does not appear to be the only mechanism involved. The occurrence of necrolytic migratory erythema in a patient with Waldmann's disease supports the current physiopathological hypothesis of the role of decreased plasma protein and amino acid levels in necrolytic migratory erythema.

Dietary Fats↗
PubMed2006

[Erythema multiforme majus and Chlamydia pneumoniae infection].

BACKGROUND: Erythema multiforme majus of infectious origin is an acute eruptive syndrome seen more commonly in young subjects and characterised by an appearance of round target lesions. In most cases, it is associated with infection involving Herpes simplex virus or Mycoplasma pneumoniae. We report an original case of erythema multiforme majus subsequent to infection with Chlamydia pneumoniae. CASE REPORT: An 18 year-old man was hospitalised for management of generalised skin rash comprising lesions in rings, associated with bullous and post-bullous lesions, chiefly in the oral (preventing eating) and genital areas in a setting of febrile cough. Various bacterial agents (Mycoplasma pneumoniae, Chlamydia pneumoniae) and viral agents were suspected, but serological testing for Chlamydia pneumoniae alone was positive with IgM of 128 IU and IgG of 64 IU. The outcome was favourable within several days following administration of symptomatic treatment (rehydration, mouthwashes, etc.) and aetiological treatment (acyclovir: 30 mg/kg/d, ofloxacine: 400 mg/d). At D15, serologic tests for Mycoplasma pneumoniae continued to be negative. Anti-Chlamydia pneumoniae IgM and IgG were 256 IU. At D30, IgM was 128 IU while IgG remained at 256 IU. DISCUSSION: The existence of a systematic skin rash comprising typical target lesions and mucosal lesions in the oral and genital areas suggested to us a diagnosis of erythema multiforme majus. Screening for the agents generally responsible was negative and drug-induced rash was ruled out. Serological tests for Chlamydia pneumoniae were positive at various times, resulting in diagnosis of erythema multiforme majus secondary to infection with Chlamydia pneumoniae. Following demonstration of the presence of Chlamydia pneumoniae using reliable methods and the elimination of other causes of erythema multiforme majus, dermatologists should opt for this aetiology in order to optimise treatment.

Acyclovir↗
PubMed1995

Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum.

PURPOSE: To evaluate the epidemiology, possible etiologic factors, complications encountered, and treatment administered to a group of patients with ocular involvement in the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum who were seen at two large tertiary referral centers over a 34-year period. METHODS: Hospital records from 1960 to 1994 at the Massachusetts General Hospital and Shriners Hospital for Crippled Children were reviewed for patients with erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis. Only patients fulfilling specific clinical diagnostic criteria and those who received a diagnosis by a dermatologist were included in the review. RESULTS: A total of 366 patients with erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis were identified. Drugs were the most commonly identified etiologic factor in all three conditions: sulfonamides were the most frequently identified agents. Eighty-nine patients (24%) had ocular manifestations at the time of their acute hospital stay. Ocular involvement was seen in 9% of patients with erythema multiforme, in 69% with Stevens-Johnson syndrome, and in 50% with toxic epidermal necrolysis. The ocular problems were more severe in patients with both Stevens-Johnson syndrome and toxic epidermal necrolysis. There was no significant difference between the number of patients who were treated with systemic steroids and those who were not (P = 0.42). CONCLUSIONS: The erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum remains an important cause of severe visual loss in a significant number of patients. Systemic steroids used during the acute phase of the disease appear to have no effect on the development of ocular manifestations. Studies on the acute immunopathogenic mechanisms occurring in these disease are warranted if more effective therapies are to be found.

Acute Disease↗
PubMed1981

Erythema annulare centrifugum.

If one reviews the literature on the subject of erythema annulare centrifugum, it becomes quite obvious there is considerable confusion about the clinical presentation and histopathologic findings. This confusion is exemplified by the various quotes from dermatologic texts and scientific publications. Darier, who originally described the disease, described an annular, indurated, erythematous lesion without a scale that histologically was characterized by a superficial and deep lymphohistiocytic infiltrate and normal epidermis. Ackerman suggested that there are two types of gyrate erythema, a superficial type showing a scale, and the deep type as described by Darier. After reviewing the literature and studying patients with gyrate erythemas, it seems that there are two distinct types best termed the superficial and deep forms of gyrate erythema. Dermatologists use the term erythema annulare centrifugum to denote both of these forms. Perhaps that term should be discarded.

Erythema↗
PubMed1984

Erythema multiforme: clinical, histopathologic, and immunologic study.

In a prospective study of erythema multiforme, forty-two cases were selected with the use of defined criteria. In thirty-three cases (79%), the erythema multiforme occurred following a lesion of recurrent herpes simplex; in four cases (10%), it was related to administration of a sulfonamide drug. Herpes-associated erythema multiforme (HEM) was largely recurrent erythema multiforme minor and was characterized histopathologically by inflammatory changes, such as spongiosis and exocytosis, and by focal liquefaction degeneration of the basal cell zone of the epidermis. Sulfa-associated erythema multiforme (SEM) was a nonrecurrent illness with widespread cutaneous and mucosal damage associated with prominent histologic necrosis of epidermal cells. The deposition of C3 and fibrin along the dermoepidermal junction and the deposition of IgM, C3, and fibrin around dermal blood vessels by immunofluorescence microscopy were similar in both groups. Although HEM and SEM may have somewhat different clinical and histologic features, there is significant overlap in the pattern of tissue damage.

Adolescent↗
PubMed1986

Oral acyclovir for the prevention of herpes-associated erythema multiforme.

Herpes simplex virus is the single most common precipitator of erythema multiforme. Typically, erythema multiforme lesions appear 10 to 14 days after a recurrent herpes simplex virus infection and attacks can be disabling when they occur at frequent intervals. Prior to the introduction of acyclovir (Zovirax), there was no effective therapy to prevent herpes-associated erythema multiforme. Four patients were treated with a maintenance dose of acyclovir for periods ranging from 10 to 26 months; there were no significant side effects from the drug and only one recurrence of erythema multiforme. Oral acyclovir may become the treatment of choice for herpes-associated erythema multiforme.

Acyclovir↗
PubMed1997

Target lesions on the lips: childhood herpes simplex associated with erythema multiforme mimics Stevens-Johnson syndrome.

Erythema multiforme and Stevens-Johnson syndrome are both characterized by areas of epithelial necrosis. An important clinical feature that distinguishes the two is the extensive mucosal necrosis in Stevens-Johnson syndrome but not in erythema multiforme. Because significant and serious complications may develop with Stevens-Johnson syndrome and not with erythema multiforme, it is important to differentiate between the conditions. We describe three boys with herpes simplex virus-associated erythema multiforme who had severe necrosis of the lips develop and were initially diagnosed with Stevens-Johnson syndrome. The lip lesions were large target lesions of erythema multiforme rather than the extensive necrosis seen in Stevens-Johnson syndrome and all three had a benign course.

Child↗
PubMed2002

Ultraviolet radiation-induced erythema in human skin.

We have evaluated UVR-induced erythema in previously unexposed buttock skin of volunteers of skin types I, II, III, and IV. Studies were done with solar-simulated radiation (SSR), UVB, and UVAI and we determined the just perceptible minimal erythema dose (MED) and, in some cases, quantified erythema with a reflectance device. The results show that there is a trend for increased SSR MED with skin type, with the MED of skin type IV being approximately twice that of skin type I, a smaller difference than one might have expected. However, there is a very considerable overlap of MED between skin types which shows that MED is a very poor indictor of skin type. Quantitative dose-response and time course studies with SSR and UVAI showed broadly similar responses when comparable MED-based exposures were given. We used our data to test the new concept of the standard erythema dose (SED) with two different erythema action spectra, and confirmed that the SED approach works with the different UVR sources that we studied.

Dose-Response Relationship, Radiation↗